Name: Minimally Invasive Bone-Tendon-Bone (BTB) Harvest Using the QuadPro™ Tendon Harvester
Uploaded: 2021-02-10T00:00:00Z
Channel: Arthrex

Christopher Kaeding, MD (Columbus, OH), demonstrates a bone-tendon-bone (BTB) autograft harvest technique using the QuadPro™ tendon harvester. This minimally invasive technique has several distinct advantages, including low morbidity, improved cosmesis with a small scar,1 reduced hypoesthesia by avoiding the saphenous nerve, minimal defect in the patella, and versatility allowing for transtibial or all-inside drilling and fixation techniques.
1. Koh E, Oe K, Takemura S, Iida H. Anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft to avoid harvest-site morbidity in knee arthroscopy. Arthrosc Tech. 2015;4(2):e179-e184. doi:10.1016/j.eats.2015.01.002

Not Hidden

English  - en

video

VID1-001933-en-US | A | Minimally Invasive Bone-Tendon-Bone (BTB) Harvest Using the QuadPro™ Tendon Harvester

Christopher Kaeding

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Videos - OP-Anleitung

Surgical Technique Videos

Vídeos — Técnicas cirúrgicas

Videos de técnicas quirúrgicas

Minimally Invasive Bone-Tendon-Bone (BTB) Harvest Using the QuadPro™ Tendon Harvester

This is new QuadPro graft harvester. We'll be using it today to demonstrate our new technique of a minimally invasive BTB graft harvest. In today's use, we will not be using the accompanying push rod. When we see this device. You can see it has a cylindrical cutting leading edge. And this is very effective at cutting both soft tissue as well as some bone. So the advantage of this new technique we're about to demonstrate is that one esthetically, the cosmesis of the scar should be much better than the traditional longitudinal scar. Number two, we're preserving the tenon. And number three, by preserving the peritoneum, we also protect the patella branches of the saphenous nerve. This hopefully should decrease the area of hypesthesia or decrease sensation. That's typical after the traditional patellar tendon harvest. We also see in this technique that we actually minimally traumatize the patella. So this would decrease patella pain as well as the risk of patella fracture. So this is a left knee. Here's the fibular head lateral side of the knee. We've outlined the inferior pole of the patella. My thumb is over the tibial tubercle. And you see these two dots have marked the superior or proximal margin of the tibial tubercle. The goal of this harvest technique is to give a more esthetically pleasing transverse incision here. And then we're going to expose the peritoneum. So we make a little incision here. So here we are raising the skin flap developing our incision a bit. So now we've exposed the peritoneum right in here. We will incise it transversely. Now you see it's developing the plane between the peritoneum and the underlying tendon. So I'm dissecting bluntly in the plane between the peritoneum unattended. Now if we pull our retractor out, you can see that here's my inferior pull the patella. And here's the tip of my scissors. So I've now defined that plane. The next step is to harvest our small tibial bone block. Here we see a skid and you see it's curved. And we will put the convex side under the peritoneum. Place this into that plane between the peritoneum and the on the tendon will keep the concave side against the tendon, because this is what we're going to use to guide our cylindrical graft harvester. And you see how we slip our skid under the peritoneum. And now I'm up against the inferior pole of the patella. So by keeping all our instrumentation on the posterior aspect of the peritoneum, we should be protecting those branches of the saphenous nerve. Our next step is now to harvest our small tibial tubercle bone block. Now, to complete our bone block harvest, I will cut across the transverse side. And I'll use an osteotomy to free up the plug. So you can see our tibial bone block has now been harvested. And above it in here we have the leading window of our tenon. So here's our tibial bone block engaging the tendon. And you can see. Here is our bertillon window right there. So here, you see, we're passing the suture through that drill hole we drilled previously just before we harvested the tibial bone plug. We now have a tag stitch on our tibial bone plug. We'll now make sure that it can pass through a ten millimeter QuadPro. And we may run off just a little extra bone that we have here on the posterior aspect. So now what we see is here's our distal graft. Here's the bone plug. We have it tagged. And then just to show everyone again here's our pair of tenon. And there's in our skid going up protecting the tenon and the saphenous nerve. And we're abutting against the inferior pole of the patella. So now we've passed our tag sutures through the opening of the QuadPro, and we can see that we can pass the graft into the harvester. So now we're demonstrating our skid under the tenon. Here's the tenon right across here. Here's our tibial bone plug that's starting to go into the into the tendon. And you can see our harvester down here will start to engage the graft. Now I'll start to advance the QuadPro graft harvester. And you see how easily it's cutting through and passing up under the skid. I've now advanced to the point where I'm hitting the undersurface of the inferior pole of the patella. So we'll take the skid out. The skid removed. You can see how the QuadPro harvester is under the peritoneum still. And we're butting against the inferior pole of the patella. You can see in the transparent portion here. Here is our tibial bone plug. So now the leading edge of the QuadPro should be engaging the patella. We're currently flexed at 90 as we start to harvest a little bone sliver off the patella. We want to flex the knee a little further. So now we'll flex the knee back to about 110. And I'm rotating QuadPro. As I advance I can feel it advancing. So now you can see we've started to engage the harvester into the inferior pole of the patella. But you can see here again the Parthenon, how well the graft harvester is slipping and sliding underneath the Parthenon. Now, as we start to harvest through the patella, we flex the knee. As we continue to flex it, we continue to advance the harvester. And as the harvester passes through the sliver of bone harvest off the patella, you can feel the graft come free. And here you can see the graft. And now it's coming through the harvester. So here we have a beautiful graft. You can see our tibial bone plug here. And then the sliver bone we take from the anterior inferior patella. And in this case we actually got a little bit more than just a sliver. Might be because of the quality of the cadaver bone. But you can see how nicely this looks. And now I can simply slide our harvester out and you can see how again, the tendons remained intact on this particular graft harvest. Our patella bone sliver is actually quite robust, a little bit more than we normally get. So sometimes you'll get a larger, thicker piece, sometimes a thinner piece. But we can demonstrate to you that you have a this leaves you a couple of options. You see how long this graft is. And we even have a little bit of this periosteum that goes above and beyond it. Here we see our graft and you can see that we've placed a traditional BTB TightRope into a bone plug that came from the tibia. Now you can see here we've run sheared this back to a more traditional, very thin wafer of bone that we took from the anterior distal patella. Now this entire graft, if we want to do an all-inside technique, we can take this and we can fold it over and you have your preference. You can fold it over this way, which is my preference with the bone out. And this gives us a 62 millimeter graft, which is a nice length for a all-inside technique. You could also take the bony fragment and fold it in, or you could even cut the entire bone fleck off. And now you have a bone tendon construct. So on this side we are going to fold it back. We'll demonstrate how we like to take it and fold it back on itself this way, have the bone side exposed, and we're going to use a FiberTag technique to secure this side of our graft. So here we see our periosteum. And our first pass will be to secure this periosteum to the main portion of the graft. You can see how nicely that pulls it together. Now we rotate the card. We find the slot and pass our suture through the slot. And this is our most distal on the end of the graft passing. We release the card. Make sure we get his distal or as far to the end of the graft as we can. And we're now making a final pass purely through the collagen, where we can dunk our suture to make it low profile in the graph. So we cerclage the graft and now we'll tie it off. You see how we've buried the knot into the graft again to keep it low profile. So now we have our graft fully prepared. And now we can proceed with our all-inside ACL reconstruction. So our graft is harvested and you can see our 25 to 30 millimeter transverse incision here. It's been shown by others that you don't need to close the defect in the patella tendon. My preference is to not go in and repair it. We have the peritoneum intact, and that even diminishes the any kind of palpable defect you can feel. Here we do see the bony defect where we harvested from the tibial tubercle. If you wish, you could take the bone trimmings from the femoral drilling and place those and pack this small defect in the tibial tubercle. We close this, typically with a subcutaneous, followed by a subcuticular stitch in the skin.

Minimally Invasive Bone-Tendon-Bone (BTB) Harvest Using the QuadPro™ Tendon Harvester

Verwandte Seiten

Knie

BTB Autograft ACL-Rekonstruktion

Operationsverfahren

Knie

Instrumente für die Entnahme und Präparation des BTB-Transplantats

Produkt